晚期卵巢癌综合治疗手术时机的选择

The Best time of Surgery in Comprehensive Therapy of Advanced Ovarian Cancinoma

目的探讨晚期卵巢癌综合治疗中手术时机的选择。方法回顾性分析1994年1月至2002年12月综合治疗晚期卵巢癌110例，根据治疗模式不同分两组，I组70例，均为III期患者，系直接手术加化疗组；II组40例，其中包括18例IV期患者，系经影像学检查，系统体检及CA125水平进行全面评估，估计难以达到满意减瘤效果者，或患者全身情况差，难以耐受较大手术者，先行新辅助化疗2-3个疗程，再行减瘤术，术后继续化疗。结果两组满意减瘤率I组为84.3%，II组为87.5%，II组较I组增高，但无显著性差异。两组3年及5年生存率分别为，I组77.1%、42.9%，II组70.0%、37.5%，分别比较无显著性差异。术后残留灶大小及化疗疗程数是影响预后的主要因素。结论晚期卵巢癌术前应综合评估，选择最佳手术时机，以提高满意减瘤效果，改善生存质量，延长生存时间。

Objective To investigate the best time of surgery in advanced ovarian cancinoma. Methods 110 cases of advanced ovarian cancer treated between January 1994 and October 2002 were analyzed retrospectively. They were divided into two groups according to the therapy mode. The first group including 70 patients with stage Ⅲ diseases, and was treated by primary operation plus post-operation chemotherapy. The second group including 40 patients, 18 of which with stage Ⅳ diseases. This group of patients was treated by 2 or 3 courses of neo-adjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy because of not being suitable for cytoreductive surgery as being evaluated by imaging studies, systematic examinations, and CA125 analyses or could not tolerable large surgery because of poor health condition. Results The satisfied cytoreductive rate of the two groups was 84.3 % and 87.5% respectively. The second group was slightly higher than the first group, but with no significant difference. The 3-years and 5-years survival rate of the two groups was 77.1% and 42.9% ; 70. 0% and 37.5% respectively. There was no significant difference between the two groups. Tumor residual after surgery and the number of courses of chemotherapy were the most important prognostic factors. Conclusion Comprehensive evaluation studies should be given before surgery for advanced ovarian carcinoma. The best operation time should be chosen to improve the optimal cytoreductive rate so as to improve the survival time and quality of life.